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Robbins Basic Pathology, 10th Edition
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• Bulleted summary boxes provide quick access to key information and
easy review of key concepts.
• Highlights pathogenesis, morphology, and pathophysiologic
content throughout.
Robbins Essential Pathology, 1st Edition
ISBN: 9780323640251
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case-based approach in a focused, multimedia learning package for coursework
and exam preparation.
• Focuses on the core knowledge of disease mechanisms and essential clinical
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• Features more than 500 images and tables that illustrate key disorders
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ROBBINS& C OTRAN
PATHOLOGIC
BASIS DISEASE
OF
RO B B I N S
&C OT R A N
PATHOLOGIC
B ASIS DISEASE
OF
T E N T H E D I T I O N
Vinay Kumar, MBBS, MD, FRCPath
Alice Hogge and Arthur A. Baer Distinguished Service Professor of Pathology
Biologic Sciences Division and the Pritzker Medical School
The University of Chicago
Chicago, Illinois
Abul K. Abbas, MBBS
Emeritus Professor and Chair
Department of Pathology
University of California San Francisco
San Francisco, California
Jon C. Aster, MD, PhD
Michael Gimbrone Professor of Pathology
Brigham and Women’s Hospital and Harvard Medical School
Boston, Massachusetts
Associate Editor
Jerrold R. Turner, MD, PhD
Professor of Pathology and Medicine
Brigham and Women’s Hospital
Harvard Medical School
Boston, Massachusetts
WITH ILLUSTRATIONS BY:
James A. Perkins, MS, MFA
Distinguished Professor of Medical Illustration
Rochester Institute of Technology
Rochester, New York
Elsevier
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ROBBINS & COTRAN PATHOLOGIC BASIS OF DISEASE, TENTH EDITION ISBN: 978-0-323-53113-9
INTERNATIONAL EDITION ISBN: 978-0-323-60992-0
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International Standard Book Number: 978-0-323-53113-9
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DEDICATION
To
Our teachers
For inspiring us
To
Our students
For constantly challenging us
To our spouses
Raminder Kumar
Ann Abbas
Erin Malone
For their unconditional support
Contributors
Mahul B. Amin, MD Karen M. Frank, MD, PhD, D(ABMM)
Chairman Chief
Department of Pathology Department of Laboratory Medicine
College of Medicine Clinical Center
University of Tennessee Health Science Center National Institutes of Health
Memphis, Tennessee Bethesda, Maryland
The Lower Urinary Tract and Male Genital System Infectious Diseases
Douglas C. Anthony, MD, PhD Ryan M. Gill, MD, PhD
Professor Professor of Pathology
Pathology, Laboratory Medicine, and Neurology University of California San Francisco School of
Warren Alpert Medical School of Brown University; Medicine
Chief of Pathology San Francisco, California
Lifespan Academic Medical Center Liver and Gallbladder
Providence, Rhode Island
Peripheral Nerves and Skeletal Muscles Marc K. Halushka, MD, PhD
Deputy Director of Education
Anthony Chang, MD Department of Pathology
Professor Professor of Pathology
Department of Pathology The Johns Hopkins Hospital
The University of Chicago Baltimore, Maryland
Chicago, Illinois Blood Vessels
The Kidney
Andrew Horvai, MD, PhD
Nicole A. Cipriani, MD Professor
Associate Professor of Pathology Department of Pathology
The University of Chicago University of California San Francisco
Chicago, Illinois San Francisco, California
Head and Neck Bones, Joints, and Soft Tissue Tumors
Andrew J. Connolly, MD, PhD Aliya N. Husain, MBBS
Professor of Pathology Professor
University of California San Francisco Department of Pathology
San Francisco, California The University of Chicago
The Heart Chicago, Illinois
Diseases of Infancy and Childhood; The Lung
Lora Hedrick Ellenson, MD
Attending Physician and Director of Gynecologic Sanjay Kakar, MD
Pathology Professor of Pathology
Department of Pathology University of California San Francisco School of
Memorial Sloan Kettering Cancer Center Medicine
New York, New York San Francisco, California
The Female Genital Tract Liver and Gallbladder
Robert Folberg, MD Selene C. Koo, MD, PhD
Departments of Ophthalmology and Pathology Assistant Professor
Beaumont Health - Royal Oak Department of Pathology
Royal Oak, Michigan The Ohio State University;
The Eye Pathologist
Department of Pathology and Laboratory Medicine
Nationwide Children’s Hospital
Columbus, Ohio
Diseases of Infancy and Childhood
vi
Contributors vii
Zoltan G. Laszik, MD, PhD Richard N. Mitchell, MD, PhD
Professor of Pathology Lawrence J. Henderson Professor of Pathology
University of California San Francisco Member of the Harvard/MIT Health Sciences and
San Francisco, California Technology Faculty
The Kidney Department of Pathology
Brigham and Women’s Hospital
Alexander J. Lazar, MD, PhD Harvard Medical School
Professor Boston, Massachusetts
Departments of Pathology, Genomic Medicine, The Cell as a Unit of Health and Disease; Blood Vessels;
Dermatology, and Translational Molecular The Heart
Pathology
The University of Texas MD Anderson Cancer Center George Jabboure Netto, MD
Houston, Texas Chair, Department of Pathology
The Skin University of Alabama at Birmingham School of
Medicine
Susan C. Lester, MD, PhD Birmingham, Alabama
Assistant Professor The Lower Urinary Tract and Male Genital System
Breast Pathology Services
Department of Pathology Scott A. Oakes, MD
Harvard Medical School Professor and Vice Chair of Research and Academic
Brigham and Women’s Hospital Affairs
Boston, Massachusetts Department of Pathology
The Breast University of Chicago Pritzker School of Medicine
Chicago, Illinois
Mark W. Lingen, DDS, PhD, FRCPath Cell Injury, Cell Death, and Adaptations
Professor of Pathology
The University of Chicago Arie Perry, MD
Chicago, Illinois Professor of Pathology and Neurological Surgery
Head and Neck Director of Neuropathology
University of California San Francisco
Anirban Maitra, MBBS San Francisco, California
Professor The Central Nervous System
Pathology and Translational Molecular Pathology
The University of Texas MD Anderson Cancer Center Edyta C. Pirog, MD
Houston, Texas Associate Professor
The Pancreas; The Endocrine System Department of Pathology and Laboratory Medicine
Weill Cornell Medicine-New York Presbyterian
Marta Margeta, MD, PhD Hospital
Associate Professor of Pathology New York, New York
University of California San Francisco School of The Female Genital Tract
Medicine
San Francisco, California Peter Pytel, MD
The Central Nervous System Professor
Department of Pathology
Alexander J. McAdam, MD, PhD University of Chicago
Associate Professor of Pathology Chicago, Illinois
Department of Pathology Peripheral Nerves and Skeletal Muscles
Harvard Medical School;
Medical Director
Clinical Microbiology Laboratory
Boston Children’s Hospital
Boston, Massachusetts
Infectious Diseases
Preface
As we launch the tenth edition of Pathologic Basis of Disease • Chapters 18 and 28, covering diseases of the liver and
we look to the future of pathology as a discipline and how the central nervous system, have a fresh look brought
this textbook can remain most useful to readers in the in by new contributors.
twenty-first century. It is obvious that an understanding • In addition to the revision and reorganization of the text,
of disease mechanisms is based more than ever on a strong many new photographs and schematics have been added
foundation of basic science. We have always woven the and a large number of the older “gems” have been
relevant basic cell and molecular biology into the sections enhanced by digital technology.
on pathophysiology in various chapters. In the previous
edition we went one step further and introduced a new We made the changes highlighted above while remaining
chapter at the very beginning of the book titled “The Cell focused on the same longstanding overarching goals, which
as a Unit of Health and Disease.” We are delighted that the serve as our guiding principles:
chapter was found useful by many students and faculty. • To integrate into the discussion of pathologic processes
Because progress in basic cell biology is moving at a very and disorders the newest established information avail-
brisk pace, the chapter has been updated significantly. able—morphologic as well as molecular.
In the preface of the very first edition (1957), Stanley • To organize information into logical and uniform pre-
Robbins wrote: sentations, facilitating readability, comprehension, and
“The pathologist is interested not only in the recognition learning.
of structural alterations, but also in their significance, i.e., • To maintain the book at a reasonable size and yet provide
the effects of these changes on cellular and tissue function and adequate discussion of significant lesions, processes, and
ultimately the effect of these changes on the patient. It is disorders. Indeed, despite the addition of new information,
not a discipline isolated from the living patient, but rather we are happy to state that the overall length of the book
a basic approach to a better understanding of disease and therefore is unchanged. One of our most challenging tasks is to
a foundation of sound clinical medicine.” decide what to eliminate to make room for key new
We hope we continue to illustrate the principles of findings.
pathology that Dr. Robbins enunciated with such elegance • To place great emphasis on clarity of writing and proper
and clarity over half a century ago. use of language in the recognition that struggling to
This edition, like all previous ones, has been extensively comprehend is time-consuming and wearisome and gets
revised, and some areas have been completely rewritten. in the way of the learning process.
A few examples of significant changes are as follows: • To make this text useful to students throughout all of their
• Chapter 2 has been updated to include novel pathways years in medical school and into their residencies—but,
of cell death beyond the long-established pathways of at the same time, to provide sufficient detail and depth
necrosis and apoptosis. Indeed, the distinction between to meet the needs of more advanced readers.
these two is being blurred. Autophagy, which has begun
to take center stage in diseases ranging from aging to We have repeatedly been told by readers that up-to-
cancer and neurodegeneration, has been revised, as have datedness is a special feature that makes this book very
the possible molecular mechanisms of aging. valuable. We have strived to remain current by provid-
• In Chapter 3, we have married morphology with molecular ing new information from the recent literature, up to the
mechanisms. Thus, different patterns of inflammation current year, and by adding coverage of the COVID-19
can be related to distinct molecular pathways. epidemic.
• Chapter 5 includes a discussion of gene editing technology We are now into the digital age, and so the text will be
and a revised and updated section on molecular diagnosis. available online to those who own the print version. Such
• Chapter 7 has been extensively revised to incorporate new access gives the reader the ability to search across the entire
insights into cancer pathogenesis, the interplay between text, bookmark passages, add personal notes, use PubMed
cancer cells and host immunity, and cancer precision to view references, and exploit many other exciting features.
diagnostics. In addition, also available online are case studies developed
• Chapter 10, covering pediatric diseases, includes discus- by one of us (VK), and revised by Dr. Alex Gallan from the
sion of newly approved therapies targeting specific University of Chicago. The cases are designed to enhance
mutated forms of the CFTR transporter. and reinforce learning by challenging students to apply
• Chapter 11, covering vascular diseases, includes discussion their knowledge to solve clinical cases. To assist in the
of clonal hematopoiesis, a newly emerging risk factor classroom, we have also made the images available for
for atherosclerosis and other inflammatory disorders. instructors on the Evolve website. Instructors may register
viii
Preface ix
at https://evolve.elsevier.com/ to gain access to the images appetite for learning beyond what can be offered in any
for teaching purposes. textbook.
All three of us have reviewed, critiqued, and edited each
chapter to ensure the uniformity of style and flow that have Vinay Kumar
been the hallmarks of the book. Together, we hope that we Abul K. Abbas
have succeeded in equipping the readers with the scientific Jon C. Aster
basis for the practice of medicine and in whetting their
